Watch out for medical field trainees.

i had event today that i think merits a post. and this does have some migraine relation.

part of training anyone into the medical field is getting noobies into offices--in my experience today, it was a physician assistant.

inadvertantly, a PA student started an initial assessment for an office visit. normally, the doctor is the only one to really do anything with me outside of the tech that takes temperature.

i was not comfortable allowing this PA student to review my info, but, i allowed--how are people going to learn about complex things unless they learn from patients?

bad move. long story short, PA triggered a near syncopal event, triggered a very massive migraine, and i left the office feeling much worse than before coming in. after this person did the initial, my doctor and i stopped at that point and directed that this person not be present.

mostly from a poorly done and extremely over-inflated blood pressure cuff. pumped up high enough (my bp runs on the low side) and long enough to shut down blood flow triggering the M, almost fainting, and chest pain.

by the looks of me, i don't look as fragile as a little old lady, however do certain things to my cardiovascular system can cause big problems.

my doc apologized up and down. it was a very good visit after the fact.

sorry for my wandering point--my M has not gone away, and the left side of my face is pretty numb. don't let someone even try "practicing" on you.

i am half-tempted to call this PA's school program director, however, i do not want the blow-back to fall on my doc. what was scary is the lack of medical knowledge this person had. i write a very detailed presentation to my doc going over things. trying to act knowledeable about thing, this PA student asked some of the most rediculous questions. i just gave a blank stare......

amazing....people with such little knowlege of medicine can cause so many issues. keep an eye out on everything. i know this is tough when our brains hurt and gosh knows what else is happening to our bodies, but we must stay wide awake. they aren't.


take care.
mgb

It's a hard call isn't it. Yes they need to learn, but how distressing that inexperience added to your problems.

One young fellow I had a few months ago at ER was the total opposite. Very very gentle and tried so hard to help. He actually had some good suggestions.

Guess it's just like the rest of life - luck of the draw.

I'm on page 17 of what so far seems to be a very interesting book called "How Doctors Think" by Jerome Groopman. The intro is discussing the downsides of how we train Drs (and other medical personnel).

The smallest procedure can have such an impact. For the past couple weeks I've been having procedures that involve needles in my back, a phobia of mine. I found a Dr that twilights me, but I'm still anxious when I go after having had to face my fears all night

I have GREAT veins, nurses love me. The nurse was prepping me and put the line in the back of my hand. And jiggled and jiggled. And dug around with the needle. And then did again as she told me how she hadn't been able to get a line in anyone all day! Then she tried the other hand. After three tries she got her boss who tapped my hand and inserted the needle right in. At that point I was bruising (am still bruised) and was agitated. The procedure did not go as well as the first two. For the first time I was nauseous all the way home.

I think the ambience created by an inept technician contributed to the poor results.

I'm sorry that happened to you, Marc. Definitely puts us in the guinea pig mode. I hope you're feeling better.

Depending on what type of questions the PA was asking you may want to follow up more with reporting him. How do you think it may blow back on your Dr.?Common sense can not be taught and this person may need to find another field where people don't get hurt.

yikes para, i've had that happen tons of times. when i was younger, i'd pass out. now i've been through stuff so many times, i can usually tough it out. that "digging" really irritates the CNS and the vagal nerve, drops your blood pressure, and you can be out in seconds.

hands can be tough. mine collapse and roll pretty easily.

for example, the PA asked why i didn't take fish oil. it's annoying to get interrogated by a student PA on an extremely complex, genetic cholesterol issue--i have a pretty good team of cardiologists. this PA student couldn't even dream of these doc's credentials and experience, but yet question where they shouldn't. had to discuss a problem from an incision cite, and the student asked a myriad of stupid questions....and i had to explain how scar tissue and nerves interact! what the heck. i don't think they knew what the heck to say or do.....

since the doc is ultimately in charge of overseeing students and patient care, i wouldn't want the office or the doc to have problems. i do think someone was talked to about this, as my doc apologized and said, "believe me, this has pretty much wrecked his day."

the student screwed up and knows it, and the person that let the student see me knows they screwed up too. i did tell the student up front this was a complex case and i was uncomfortable with them, but allowed it.

the office staff is awesome and extremely helpful. but the student's interaction with patients really needs to be addressed. this is the learning "pearl" for this student, and PA program. i'm sure the doc will go over with the student the issue. i told the student it was nothing personal. but the issue was significant. the student's acutal clinical technique was so poor, that it triggered a neuro & vascular event.

i had an invasive cardiology resident insert the sheath into my femoral artery during a heart cath and not use enough pain meds.....now that hurt.

Sounds like you covered it without being vengeful or nasty. That never gets addressed and just makes folks defensive.

Hunh, so it's a vagal nerve and not me just being a weinie? I thought it was my anxiety that was making me feel woozy. Good to know. I was half way blaming myself! But, jiminey, it does smart!

Marc & Charlotte,

I'm so sorry. I know what you mean about appreciating that medical students need to learn. But at the same time, they need to temper their " enthusiasm " and recognize that their knowledge is limited.

Because my appendix had burst and there was a raging infection in my abdomen, the doc had to make a rather large abdominal incision.

Well, one day a RN student came in to see me. Perhaps she had been studying things that go wrong after abdominal surgery. Whatever, the case, she scared me so badly that I was almost afraid to breath. She told me these horror stories about how sometimes the incision tears open and the intestines spill out. Now if she had given me some numbers, such as the percentage of abdominal surgery patients that happens to, I could have dealt with it a lot better.

It is not a good idea to tell such tales to surgery patients in extreme pain and loaded out of their minds on morphine. I really didn't have anything else to do but lay in the hospital bed with all my tubes and pumps - and worry.

I didn't want to get the nursing student in trouble but I did think it was important that someone had a talk with her. I told my Dr and the charge nurse. They both were fairly upset. I heard that the charge nurse and her instructor had a talk with her.

Chris

ahh, crt....that's nuts! nothing like telling someone horror stories in that type of condition!

i think most people gain some wisdom as they age and see things, but sometimes they get ahead of themselves.

i think most patients try to be "good" patients....be polite, respond politely, etc. sometimes though the noobs go too far.

and for the more how shall i say medically challenged patients out there, we really don't have much room for playing around.

there's no room for cowboys when it comes to healthcare.

i generally am open for residents to peak in on stuff and procedures because i have some pretty rare issues--maybe what the docs learn about me can be passed on to help someone else. but when it comes to making an experience painful to a patient, you have to draw the line.

people have to learn, but do they have to learn on us???

i think what bugs me is some of this stuff that i've had happen today we were taught to recognize and avoid as first responders & in lifeguard training.

if basic sense like that is being missed, it's concerning. i passed out one time in an invasive cardiologists office on the table. my dad grabbed my legs and held them up in the air. the doctor asked my dad what he was doing....

my dad responded with you **&^&^%%, i'm trying to get blood back to his brain. basic, basic stuff.

I've had enough "interesting" things happen to me over the years. If a resident or student is there at my appointment, they are allowed to stay if it's just a "talking" appointment (or a recheck). Anything beyond it, take a hike. I made an appointment to see my doctor, not some student or resident and my time is valuable.

I've also had a resident ordered from my room by the attending doctor. She messed up and the doctor was not happy and was told to find another place to be...good thing cause I was ready to throw something at her.

As for the veins and blood draws...I'm another like Marc. Good luck and I love nurses and techs that can get it on the first try. Usually I look like a pin-cushion as the veins move or they aren't where they are supposed to be.

Sorry, Marc..glad, that after the PA left your appointment went well..so sad that you became so ill during your appointment.
"
My veins collapse easily..blood draws and IV's are a nightmare..they always say . ".Oh, I can do it "..after I've been poked way too many times..had IV's in my neck and feet..my husband..likes to take pictures during my visits..not pretty

I've had my share of students as a pt and I've also had my share of students as the mentor.

As a guide, I teach as much empathy as humanly possible. It's hard for some docs, who can spend a whole year perched over a cadaver slowly inspecting and cutting every millimeter of them. They often spend that whole time trying to remove themselves from the fact that they are cuttng up a human body.

Then when they finish medical school and deal with live humans they often still have the idea not to have feelings about the patient. It gets drummed in to them not to get emotionally involved...which for a concrete thinker means not to let it look like you care.

The whole time I am with them I show them how it is possible to be kind, respectful and caring without becoming emotionally over-invested.

It's the same with using humour. So many of them are taught that joking around is not professional and is inappropriate with mental health consumers, yet one of the best ways to start off the therapeutic relationship is to try out some humour.

Telling someone the risks after surgery is not inappropriate, however, it's how it is done that makes the difference. Part of that nurses job was to let you know the risks and what to look out for and be careful of after your surgery....but scaring the heck out of you was obviously not the correct way to do that teaching.

And then there are the ones I loath. The new docs that know EVERYTHING. Too new or bullheaded to understand that no one knows everything and that there are not always answers to every question.

I've had some great ones, but they are always the ones that want to learrn from the pateint as opposed to try to teach the patient.

The best work-up I've ever had done in an ER was from a student. He was so great and took the time to understand that perhaps I may have some useful info to guide my care. Ultimatley his care led to me getting referred to the doctor that has helped me the most.

I do think that if I was paying for each individual appointment, rather then for blanket healthcare, that I would have a bit more problem with crappy students. I guess because it's blanket care I just figure I can always come back and try a second go at it. If I was paying for each visit I don't think I'd be so understanding.

this was pretty much an isolated incident. i'm now seen by the big docs, with every once in a while with some residents. too complex of a case for anything to be mis-interpreted.

i've got enough goofy things going on, that it borders on negligence to let a noob stumble on me now.

big appointments tomorrow. neurosurgeon and and a pit. tumor specialist.

I am sorry your suffered so, Marc. And, I am glad you have a good doc.

In defense of med students (and I presume PAs) they are given so much information it is like trying to drink all of the water coming from a fire hose. Sometimes I takes them time to remember some of the basics, I am afraid.

I have always been asked if it is okay if the student stays. However, if it is a teaching hospital I don't really feel I have a choice. That being said, they have to learn on someone and why not someone odd like me. It was still very difficult when I was at the gyno/onco and I had THREE doctors stacked up looking over each shoulder for a pelvic exam! I was literally about to pass out from the embarassment which my husband noticed and all the drs missed because they were so interested in the reconstruction from my surgery.

I just don't think it occurred to the doctors that were fascinated by my "1 in a million" cancer that I had other more immediately pressing health issues. Not bad doctors, just focused on their own specialty and not the entire patient. Seems to be a common theme as I see more doctors.

You are right but it isn't just students we have to be aware of. My own GP had no idea PPIs could cause headaches until I told him and he verified it. since I know he treats my sister and my best friend for migraines that is important!

Sorry, for wandering. I am glad you survived your event w/ no permanent damage ad that you are sharp enough to manage your care. So many people aren't!

Oh Gosh Marc what an unfortunate, bad incident. I am so sorry it happened to you.

I wish it didn't happened.

hugs,
Risa

I'm sorry you had such a bad experience, Marc. I would like to say that my dad actually prefers getting residents as his doctors. In fact, he used to go to a resident as his primary doctor because he knew that she was always being checked up upon. He saw as her attending doctor followed behind her periodically in the hospital and made sure that she was doing the right thing. He felt more confident with her because he knew that he was getting the opinion of both the resident, in whom he already had a lot of confidence, and her supervisor, who by definition had to be someone fairly senior in the office to be assigned the task of supervising the residents.

He said that during his second pulmonary embolism, his ICU bed was constantly surrounded by residents, who were eager to get experience with that problem (this was just after they had developed the clot-busting drug; with his first pulmonary embolism, they had to give him a lot of heparin for several days straight to thin the clot, but with the second one, a new drug had it gone in two hours!). And my dad said that the overseeing doctor was very alert to make sure that they behaved appropriately, but also got well trained.

Whenever I have gone into the hospital, I am always seen by the residents primarily, with my doctor controlling the treatment after consultation with them. But it helps that my neurologist is the neuro in charge of all the residents, so they would have reported directly to her even if she wasn't already my doctor. So they have a good working relationship already, which I feel makes a big difference.

I wonder too if the location makes a difference. I asked my doctor once why such a large number of people applied to work at my hospital, and she said that it's in Hollywood, everyone's dream location! So because so many people want to live in Hollywood (or maybe somewhere a bit farther away and safer!), she has a large and good pool to choose from. She feels that she is able to select really high quality residents as a result. So this may also have an effect on why I have always had good results from the residents I have seen.